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How to Add a Letter of Disagreement to Your Medical Record by John Backster

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How to Add a Letter of Disagreement to Your Medical Record by
Article Posted: 08/19/2013
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How to Add a Letter of Disagreement to Your Medical Record

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As per the provisions of the Federal Health Insurance and Portability Accountability Act (HIPAA) and applicable state law, I am requesting an amendment to my mental health medical record held by your facility. Please include this letter and the information contained in it as part of my medical history. This letter should be attached to my medical record when copies are requested by other medical facilities, or authorized parties per state law, or my written permission.

While I respect the opinion of my treating physicians, I am disputing any reference in my medical record which indicates a diagnosis of a mood disorder, thought disorder, manic episode, psychosis, or any symptom that suggests evidence of a major mental disorder. I am referring to psychiatric disorders listed in the current version of the Diagnostic Statistical Manual. Specifically, I am expressing my disagreement with the diagnosis of bipolar disorder which has been applied to me by medical doctors over the past fifteen to twenty years. The comments in this paper refer to all psychiatrists and physicians who have diagnosed me with this condition.

The bipolar disorder label has caused me significant hardship and frustration for many years as a consumer of the mental health care system. My long exposure to neuroleptics has resulted in dystonic tremors in my hands. This was an absolutely avoidable outcome and is totally unacceptable.

Let me say that it behooves the mental health professional to carefully consider the complaint of an individual being seen for the first time. When a psychiatrist finds the person to be taking a mood stabilizer or anti-psychotic medication the provider should not make assumptions about the patient’s condition. A person’s use of psychotropic medications by itself should not be taken as proof of a mental illness.

A patient’s medical history is also of limited use in rendering an accurate psychiatric diagnosis. At least in my humble opinion. Reliance on the patient’s medical record may be appropriate to an extent. However, this practice can be deceptive. The relationship between a psychiatrist and mental health patient is markedly different from the traditional doctor/patient relationship. Allow me to explain.

During my time as a consumer of the psychiatric system, I became conditioned to provide my treaters with the information I thought they wanted to hear. After many years in the mental health care system, a patient identifies himself or herself as an integral part of the psychiatric community. Consumers of the mental health care system learn to play the role of “psych patient.” Patients are subconsciously trained give the treater what (the patient believes) he or she wants to hear. Therefore, I advise the mental health professional against relying on any verbal statements made by a patient.

I feel it would be appropriate to give at least one proper unbiased medical evaluation before diagnosing a patient with a major mood or psychotic disorder. This assessment should be done without referring to a previous medical record or consultation with a former medical provider. The techniques used to come up with psychiatric diagnoses are far from perfect and prone to error. I originally came up with the bipolar diagnosis from watching a film at my local hospital. I expressed my suspicions of manic depression to my treating physician at the time. As one would expect, this psychiatrist agreed with my observations and this diagnosis has stuck with me ever since.

Where my medical records indicate I showed clear instances of bipolar mania, my wife will confirm that there were many stressful events in our lives that produced high anxiety in both of us. My wife believes that any erratic behavior I might have displayed at those times could have been related to our difficult circumstances. My wife is quick to state that this stress was primarily caused by my inclusion in the mental health care system.

In fact, my wife of 20 years, her family, and friends will confirm that they have seen no evidence of a mood or psychiatric disorder in my behavior. I have repeatedly asked people who know me personally if they have ever witnessed me exhibit any behavior that my doctors would call manic. The answer has always been a resounding “No.” It’s also true that no person has ever stated I have any kind of mental illness unless I mentioned it first.

I have spent many years in my thoughts debating whether or not I am “normal.” Occasionally I would pose this question to my close friends and family members. Their sincere answers have always confirmed that I am mentally stable. Am I to take the word of the medical professionals who see me for a half hour every two to three months, or the people who have known me for over 20 years?

I have never voluntarily committed myself to a psychiatric hospital for my supposed bipolar illness. Nor have I ever been involuntarily committed to a mental hospital, except in the case where I was hallucinating from the side effect of a medication that was improperly prescribed to me. I will also point out that I have never been arrested other than for a driving offense. Once again, this offense was related to the side effect of a medication. Both of these incidents contributed to my trauma from being part of the mental health care system. With respect to financial irresponsibly, it should be noted that many debtors do not exhibit the well-known manic symptoms of bipolar disorder. For myself, I attended debtors anonymous for several months. I also attended the Dave Ramsey Financial Freedom course. I have not had the urge to open a credit card account or take out a personal loan in over five years. I am not sure if a person diagnosed with bipolar disorder would be able to resist the compulsion to go on a classic manic spending spree.

A review of my medical records will show that I have essentially been on the same medication treatment plan for at least fifteen years. The financial debacle I mentioned occurred around 2008. This event was wholly related to a business venture. I believe my financial troubles stemmed from poor financial management and lack of adequate business training, and not from a manic episode as my doctors allege.

The national debt is soaring to a frightening twenty trillion dollars. Is that an indication that our leaders are manic? Perhaps the president and members of congress are in need of mood stabilizers and anti-psychotic medications. Putting our leaders on psychiatric medication may help stabilize the American economy. The sarcastic tone of those last few sentences is being directed at the psychiatric community, not the government.

Risperdal was removed from my treatment plan at the beginning of 2013. My mood and behavior has remained stable since then. Please understand that my previous treaters insisted that an anti-psychotic drug was a necessary part of my treatment plan to maintain my mental stability. My current mental status indicates that this belief was incorrect. Since discontinuing Risperdal, my memories and emotions have become more intense. The memories of my experience in the mental health care system are overwhelming at times. However, being off of Risperdal, I can honestly say that my thoughts are much clearer. I am also more productive (in a normal way).

I do acknowledge the sensibility of a diagnosis of executive dysfunction disorder recently made by a neurologist at **** Hospital in San Diego, CA. I recall seeing this diagnosis in a neuropsychological report at the time I was being treated at **** Hospital in San Diego, California. My original complaint to my primary care physician in 1995 (prior to entering the mental health care system) concerned a memory issue. This doctor immediately concluded my memory issue to be adult attention deficit disorder (ADD). I was referred to a psychiatrist for this condition. My psychiatrist immediately prescribed stimulants to correct the condition. This was done without even a brief discussion of my symptoms.

My treatment in the mental health care system continued to escalate to include diagnoses that ranged from Asperger’s syndrome to psychosis. I received the Asperger’s diagnosis after undergoing extensive neuropsychological testing. This conclusion was quickly dismissed by my psychiatrist at that time, who stood by the bipolar disorder label.

The neurologist whom I believe correctly diagnosed me with executive dysfunction disorder asked me several questions as part of a Review of Systems. I repeated the usual answers that would indicate a mood disorder. Based on this review the physician determined I am positive for bipolar disorder. Once again, I disagree with this opinion.

With regard to encounter date May 2, 2013, on page one of my neurological record:

Wikipedia states the following about the 14 point Review of Symptoms:

“A review of systems (ROS, also called a systems enquiry or systems review) is a technique used by health-care providers for eliciting a history from a patient. It is often structured as a component of an admission note covering the organ systems, with a focus upon the subjective symptoms perceived by the patient (as opposed to the objective signs perceived by the clinician). It can be particularly useful in identifying conditions that don't have precise diagnostic tests.”

This information indicates that the 14 Point Review of Symptoms is based on patient self-reporting and by itself is unreliable in determining a psychiatric diagnosis. Patients are not always the best source of information concerning their physical and mental state. I am sure many mentally ill persons deny their need for treatment. Should the mental health professional accept the patient at his or her word? That’s not for me to say. I would propose that patient self-reporting should not be solely relied upon as means of making a medical diagnosis.

In the psychiatric community, patient self-reporting seems to be the primary method of diagnosing a person. This is especially true when the individual has not come through the system by way of a voluntary or involuntary commitment. Medical providers need to be mindful that an incorrect psychiatric diagnosis can have a devastating impact on the life of a patient. I implore mental health professionals to be responsible in applying psychiatric labels and in dispensing dangerous drugs.

Wikipedia also states the following concerning the relationship between executive dysfunction and bipolar disorder:

“Bipolar disorder is a mood disorder that is characterized by both highs (mania) and lows (depression) in mood. These changes in mood sometimes alternate rapidly (changes within days or weeks) and sometimes not so rapidly (within weeks or months). Current research provides strong evidence of cognitive impairments in individuals with bipolar disorder, particularly in executive function and verbal learning. Moreover, these cognitive deficits appear to be consistent cross-culturally, indicating that these impairments are characteristic of the disorder and not attributable to differences in cultural values, norms, or practice. Functional neuroimaging studies have implicated abnormalities in the dorsolateral prefrontal cortex and the anterior cingulate cortex as being volumetrically different in individuals with bipolar disorder.

Individuals affected by bipolar disorder exhibit deficits in strategic thinking, inhibitory control, working memory, attention, and, initiation that are independent of affective state. In contrast to the more generalized cognitive impairment demonstrated in persons with schizophrenia, for example, deficits in bipolar disorder are typically less severe and more restricted. It has been suggested that a “stable dys-regulation of prefrontal function or the subcortical-frontal circuitry [of the brain] may underlie the cognitive disturbances of bipolar disorder”. Executive dysfunction in bipolar disorder is suggested to be associated particularly with the manic state and is largely accounted for in terms of the formal thought disorder that is a feature of mania. It is important to note, however that patients with bipolar disorder with a history of psychosis demonstrated greater impairment on measures of executive functioning and spatial working memory compared with bipolar patients without a history of psychosis suggesting that psychotic symptoms are correlated with executive dysfunction.”

Wikipedia is certainly not an authoritative source on the subject of executive dysfunction disorder versus a mood disorder or psychosis. I feel it presents enough plausible information (in my case) to warrant consideration of a cognitive disorder, as opposed to a mood disorder. I am suggesting this possibility without having to write a dissertation on the subject. Needless to say, I am proposing executive dysfunction disorder as my correct diagnosis as opposed to bipolar disorder. Society has an entirely different view of a neurological versus a psychiatric label. The differences may be slight, but there is a difference in how the disorders are perceived by members of the public. It’s entirely possible that my treaters mistook my manic-like symptoms to be bipolar disorder, rather than executive dysfunction disorder.

I feel that the psychiatrists at **** Hospital were primarily responsible for my terrible experience in the mental health care system. I was a patient of this prestigious mental health facility for at least ten years. Their resident physicians handled the majority of my medical care as a veteran psychiatric patient. Their decision to maintain my treatment plan with Risperdal is directly related to my dystonic tremors. It is difficult for me to use my hands for tasks such as writing. This is not okay. I take responsibility for my role as a patient in the creating this outcome. I did not have to go along with their flawed treatment plans.

I admit to having a disabling case of general anxiety and social phobia. I certainly had teenage depression. My brief periods of depression as an adult were reasonable in my mind due to my personal circumstances at those times. Living with the bipolar disorder label, and internalizing my psychologist’s statements that I was unable to maintain meaningful employment, certainly contributed to my depressive episodes.

I also realize that an individual’s intelligence, such the ability to write and speak eloquently often have little or no relationship to a person’s mental and emotional state. This fact was brought to my attention by my current treater. Nonetheless, I stand by what I have put down in this paper. I do not agree to the bipolar disorder diagnosis.

I am agreeable to taking one psychiatric medication for whatever medical condition I may have. At one time, I was taking seven different medications for my condition and over a dozen pills a day. I was totally sedated and unable to think and function normally. This practice of over-medicating patients should be stopped.

I imagine that my request to add this paper to my medical record will itself be construed as a manic act of some sort. This remark comes from the cynicism I have developed as a disrespected, yet crucial member of the psychiatric community.

When a medical professional applies a mental disorder label to an individual, this highly educated and influential person, is unequivocally stating that the person has something “wrong” with him or her. I say this because of society’s view of the mentally ill population. A careless diagnosis of bipolar disorder has devastating effects on the life of a person labeled with a major mental disorder. This is something a mental health provider will never experience.

Thank you for your time and consideration.

Respectfully yours,

John Backster

Related Articles - HIPAA amend medical records, amend psychiatric records, amend mental health records, dispute medical diagnosis, dispute medical records,

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